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The Shoulder.

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Presentation on theme: "The Shoulder."— Presentation transcript:

1 The Shoulder

2 Introduction Components of the shoulder Most common joint pathology
Rotator cuff Biceps Tendon Fractured neck of Femur Dislocation Adhesive Capsulitis

3 3 components The glenohumeral joint The acromiclavicular joint
The scapular

4 Diagnosis History Range of Movement Palpation Pain
Diagnostic tests (there are 65 that can be performed!)

5 Most common joint pathology
Gh joint Ac joint Scapular Adhesive capsulitis OA (rare) Dislocation Tendonitis Impingement Instability

6 Shoulder or cervical nerve root?
Is there loss of shoulder ROM? YES = SHOULDER Are the reflexes reduced? YES = CERVICAL

7 Rotator Cuff Stabilise the head of the humerus while the other major muscles around the shoulder are actively moving the arm. Eg. When deltoid is abducting. They also initiate most movements

8 3 main types of rotator cuff lesions
Tendonitis Partial rupture Complete rupture

9 Tendonitis Infraspinatus and Teres Minor Laterally rotate humerus
Supraspinatus Initiates abduction (Most commonly injured) Infraspinatus and Teres Minor Laterally rotate humerus Subscapularis Medically rotate humerus Painful arc at 90° abduction Toothache type, constant pain from acromion to deltoid insertion Reverse scapular pattern Painful arc at 90 abduction Resisted gh lateral rotation Thickened tendon posterior to ghjt Painful medial rotation

10 Treatment of tendonitis
Early stages Later stages Frictions Ultrasound Strengthening exercises in pain free range Scapular control Shoulder taping to offload tendon Antiinflamatories Stretching exercises

11 Rotator cuff rupture Partial rupture Complete rupture
Cause usually traumatic As tendonitis but pain is sharper Resisted abduction very painful Passive elevation not affected Cause fall onto point of shoulder with arm adducted/spontaneous due to degeneration Acute pain Inabiltiy to initiate abduction Full passive rom if helped through first 20-30º

12 Rotator Cuff strengthening
Sidelying Lateral Rotation

13 Rotator Cuff strengthening
Prone Horizontal Abduction

14 Rotator cuff strengthening
Lateral rotator strengthening with resistance band

15 Biceps Tendon Tendonitis Rupture Pain in bicipital groove
Pain on resisted forearm supination and elbow flextion Buldge in lower third of upper arm.

16 Fractured neck of femur
Pain on early movement Upper arm swelling Need to be investigated early especially following a fall in the elderly Should be kept moving as much as possible

17 Ghjt disclocation Carries a very specific history of trauma
- anterior dislocation (abduction, extension and lateral rotation) Usually involves tear of labrum Physio aims to strengthen rotator cuff After 3rd dislocation surgery is usually necessary

18 Adhesive Capsulitis/Frozen shoulder
inflammation of the shoulder capsule and synovial membrane leading to adhesion formation. This causes a thickening in the capsule and constriction of the glenohumeral joint due to the scar tissue forming in the capsule

19 Diagnosis Age 40+ Cause ? Unknown
Possible: trauma, wrench, dislocation. CVA, heart conditions, diabetes, viral. Can also be secondary to cx spondylosis or to tendonitis.

20 Clinical features

21 Clinical features Increasing dull ache over a few months duration.
Sharp pain when reaching the end of pain free movement Loss of movement in a capsular pattern – lateral rotation – abduction - flexion Most reduced >>>>>>>>>Least reduced Elevation and protraction of shoulder girdle

22 Clinical features cont’
Pain over A/C joint and deltoid muscle – can spread to neck and/or elbow All G/H movement often painful, not specific planes Pain worse at night

23 Clincial features cont’
Muscle spasm in pectoralis major and latissimus dorsi Wasted deltoid  Associated posture Dowagers hump Poke chin

24 Prognosis 18 months to 3 years 3 phases
Freezing –painful phase (worse at night and when lying on it) Frozen – stiff phase Thawing- stiffness gradually eases

25 Physiotherapy Reduce pain with electrotherapy, TENS and acupuncture until patient is able to sleep and function day to day Taping to rest the joint Static strengthening exercises for the shoulder Introduce stretching in sub acute phase

26 Exercises to increase rom

27 Other treatment Antiinflamatories Muscle relaxants
Hydrocortisone injection Nerve block Surgery – Manipulation/Arthroscopic capsular release

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